Healthcare Provider Details

I. General information

NPI: 1881946127
Provider Name (Legal Business Name): CHRIS ATTAWAY ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 WALNUT GROVE RD
MEMPHIS TN
38120-2104
US

IV. Provider business mailing address

5900 WALNUT GROVE RD
MEMPHIS TN
38120-2104
US

V. Phone/Fax

Practice location:
  • Phone: 405-314-4831
  • Fax:
Mailing address:
  • Phone: 405-314-4831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096.003423
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1881
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: